This form sets forth a formal notice from a company to its employees regarding changes
to an incentive payment plan, as well as an acknowledgment and agreement by the
employee to such changes. It provides language to advise employees of the effective
date of the change as well as notify them as to the exact changes and their effect on the
employee. This document contains standard terms as well as opportunities to provide
optional language. This document is useful to employers seeking to communicate
changes to incentive pay plans.
[Instruction: Insert company logo/letterhead here.]
Notice and Agreement Regarding Change of Incentive Pay Plan
Notice Date: _____ [Instruction: Insert notice date.]. This change to the incentive pay plan
policy supersedes all previous versions of the incentive pay plan.
This shall serve as written notice to all employees of _____ [Instruction: Insert company
name.] that as of ____, [Instruction: Insert effective date change.] the incentive pay plan
currently in effect will changed in the following manner _____ [Instruction: Insert description
of change.], and the following new incentive pay plan will be placed into effect:
[Instruction: Insert new incentive pay plan. If no incentive pay plan will be in effect, revise the
foregoing language to state same.]
[Optional language: Employees eligible for any payment and/or benefit under the previous
incentive pay plan are hereby notified that any payments and/or benefits which have
accrued and are currently due and owing to such employee will be paid in full in the next
pay period. However, such payment and/or benefits will cease to accrue as of the effective
date noted above.]
These changes to the incentive pay plan affect the following employees: _____ [Instruction:
Insert applicable information.]
If you have any questions regarding this Notice, or the changes detailed herein, please contact
____ [Instruction: Insert contact name.] prior to signing the acknowledgment and agreement
below. Employees are also advised they may seek legal advice regarding their rights to any
incentive pay, at their sole cost and expense, and in their sole discretion, prior to signing this
I hereby acknowledge I have received and had an opportunity to review this notice. I agree to
the terms of the revised incentive pay plan notice and understand my rights as they exist.
Date of Agreement
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